A practical implementation of the 2010 IPEM high dose rate brachytherapy code of practice for the calibration of 192Ir sources.

This paper details a practical method for deriving the reference air kerma rate calibration coefficient for Farmer NE2571 chambers using the U.K. Institute of Physics and Engineering in Medicine (IPEM) code of practice for the determination of the reference air kerma rate for HDR (192)Ir brachytherapy sources based on the National Physical Laboratory (NPL) air kerma standard. The reference air kerma rate calibration coefficient was derived using pressure, temperature and source decay corrected ionization chamber response measurements over three successive (192)Ir source clinical cycles. A secondary standard instrument (a Standard Imaging 1000 Plus well chamber) and four tertiary standard instruments (one additional Standard Imaging 1000 Plus well chamber and three Farmer NE2571 chambers housed in a perspex phantom) were used to provide traceability to the NPL primary standard and enable comparison of performance between the chambers. Conservative and optimized estimates on the expanded uncertainties (k = 2) associated with chamber response, ion recombination and reference air kerma rate calibration coefficient were determined. This was seen to be 2.3% and 0.4% respectively for chamber response, 0.2% and 0.08% respectively for ion recombination and 2.6% and 1.2% respectively for the calibration coefficient. No significant change in ion recombination with source decay was observed over the duration of clinical use of the respective 192Ir sources.

Organ doses from prostate radiotherapy and associated concomitant exposures.

In addition to the therapeutic exposure, a course of radiotherapy will involve the additional (concomitant) irradiation of the patient using CT, simulator or portal imaging systems, for localization of the target volume and subsequent verification of treatment delivery. The number of concomitant exposures is likely to increase as the developing technical capabilities for conformal, image-guided radiotherapy make target and critical organ definition an increasingly important aspect of radiotherapy. Estimation of doses and risks to critical organs in the body from all sources is thus necessary to provide the basis for adequate justification of the exposures as required by ICRP. In this paper, doses to selected organs and tissues for which ICRP have identified fatal cancer probabilities have been measured using a realistic anthropomorphic phantom loaded with thermoluminescent dosemeters and irradiated using a treatment protocol for radical radiotherapy of the prostate. Independently, doses to the same organs and tissues have been measured from concomitant CT and portal imaging exposures given for localization and verification purposes. Although negligible in comparison with the target dose, realistic numbers of concomitant exposures give a small but significant contribution to the total dose to most organs and tissues outside the target volume. Generally, this is in the range 5-10% of the total organ dose, but can be as high as 20% for bone surfaces. These data may be used to estimate concomitant doses from any combination of CT and portal imaging and may help in the justification process, especially when additional verification exposures may be required during treatment.

Comparison of patient dose from imaging protocols for dental implant planning using conventional radiography and computed tomography.

OBJECTIVES: To compare the radiation doses from imaging protocols for dental implant planning either using conventional radiography only (dental panoramic radiography (DPR), cephalometry and linear cross-sectional tomography) or involving computed tomography (CT). METHODS: Organ absorbed doses were measured using a female Rando anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters (TLD). Standard mandibular protocols for dental implant planning were followed using either a conventional dental radiographic unit (PM 2002 CC Planmeca, Helsinki, Finland) or CT scanner (Excel Twin Elscint, Haifa, Israel). Organ absorbed and effective doses were calculated. Effective dose was calculated using two approaches, one based on the ICRP method which excludes the salivary tissue from the remainder organs (designated E(exc)), and the other with its inclusion (E(inc)). RESULTS: The greatest individual organ doses for any examination were measured in the salivary tissue. E(exc) for panoramic, cephalometric and cross-sectional tomography using DPR was 0.004 mSv, 0.002 mSv and 0.002 mSv, respectively, whereas with CT it was 0.314 mSv. The value of E(inc) calculated using these data was between two and five times E(exc). CONCLUSIONS: E(inc) greatly increases the apparent radiation burden, especially with high dose procedures. CT techniques can provide excellent images, but at the cost of increased radiation detriment. DPR with a cross-sectional tomography facility may give adequate clinical information at a greatly reduced dose.

Receptor dose in digital fluorography: a comparison between theory and practice.

A method of identifying the dose per image when quantum mottle no longer dominates the image statistics is presented as a first step towards quantitative optimization in native and subtracted digital fluorography. The method is based on measurements of threshold contrast over a range of receptor doses and the application of a simple model of the threshold contrast detection task to estimate the magnitude of system noise sources. The point at which system and quantum noise sources are equal in magnitude is proposed as the practical upper limit for dose per image. The method is applied to a typical digital fluorography system and the results are placed into the context of the range of dose per image values found from a regional survey of digital fluorography units. While there is broad agreement between the dose per image values in the survey with values predicted from the experimental method, the considerable spread in survey doses suggests there are instances where the use of a high dose per image is unjustified.

Optimisation of patient doses in programmable dental panoramic radiography.

OBJECTIVES: To estimate the radiation-related risk associated with twelve imaging programs available on the Orthophos (Siemens, Erlangen, Germany) dental panoramic radiography unit. METHODS: Organ absorbed doses for each program were measured using a Rando anthropomorphic phantom loaded with thermoluminescent dosemeters. Effective dose (E) was calculated in two ways; first, using the method recommended by the International Commission on Radiological Protection, which excludes the salivary glands (designated Eexc), and second, with its inclusion (designated Einc). Organ and effective doses were both used to compare the various imaging programs. RESULTS: In 11 of the 12 programs studied the salivary glands received the highest individual organ dose, and Einc was found to be up to double Eexc. When the image was restricted to the dentition (program 2) organ doses were lower than for the complete jaws (program 1) by up to 85%, and Eexc and Einc reduced by about one half. When programs 2 and 6 (to image the temporomandibular joints) are used in place of program 1, the former combination provides more image information at an equivalent risk. CONCLUSIONS: The value of E in panoramic radiography depends on the inclusion of the salivary glands in the calculation and the magnitude of the dose.

Organ absorbed doses in intraoral dental radiography.

A dental radiography unit operating at 70 kV (nominal) and 20 cm focus-skin distance was used to irradiate an anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters, in order to assess the variation in organ absorbed dose with intraoral periapical radiographic view. 14 views using the bisecting-angle technique and four views using the paralleling technique were studied. The results are presented and the doses and dose distributions examined. Doses for the paralleling and bisecting-angle techniques are compared, and the effects of focus-skin distance and beam collimation upon patient dosimetry discussed. Sources of uncertainty in dental dosimetry studies using phantoms are also considered.

Dose reduction in panoramic radiography.

A modern programmable panoramic radiography unit was used to irradiate an anthropomorphic phantom in order to assess the variation in organ absorbed dose and calculated effective dose with program selection. The results of the measurements for five of the 12 programs available are presented, together with those obtained from an older, non-programmable unit. The results of dosimetry measurements are compared between units, between programs, and with previous data. Variations in radiation dose and their implications are discussed, and the opportunities for reductions in organ dose and effective dose of up to 85% and 50%, respectively, demonstrated.